“Missing Milestones”

Missing milestones are known to be a normal variant of development. The purpose of our study is to find if missing milestones always lead to normal development?

METHODS

This is a prospective case study on seven patients referred for motor developmental problems from July 1997 to February 1998 and then followed over a 2-year period. On each attendance, the multi-disciplinary team assessed children

RESULTS

We present a case series of seven children with “missing motor milestones”. Six of the seven, had tactile defensiveness but absent parachute reflexes on presentation

At the end of the two year period, 3 infants had normal development (Group I). One was discharged after 7 months. The second one had speech problems most likely secondary to her bilateral serous otitis media, with no other developmental problems. The third child acquired age appropriate milestones before the care was transferred to another hospital. Of the four in Group II, three developed global developmental delay and the fourth was diagnosed to have multiple cavernous haemangiomata in the brain. The pre-school alert panel was alerted for two of them possibly needing future help in school

Five of the seven children in our study were still being followed up after two years

CONCLUSIONS

Missing milestones in a subject can be a benign variation of normal motor development. However, they may also be the first sign to appear in children with neuro-developmental disorders

Tactile defensiveness may be the most useful early sign to enable the early diagnosis of non-weight bearing children with 'missing milestones'     

“Abstinence” and “nonabstinence” models for the treatment of bulimia

One of the most controversial dimensions along which developing therapeutic approaches for bulimia can be differentiated is their allegiance to an “abstinence” or “nonabstinence” model. Through analogy to traditional treatment programs for chemical dependency, many self-help and professional programs for bulimia hold that the complete elimination of binge-vomiting behavior is a prerequisite for therapeutic work, and require abstinence from the inception of treatment. In contrast, the nonabstinence model suggests that a more gradual reduction in the frequency of episodes may be preferable in that it provides more opportunities for relapse prevention training and avoids reinforcing dichotomous thinking styles. The present paper reviews the theoretical and clinical arguments that have been advanced by each side, including the case for classifying bulimia as a substance abuse disorder. A strategy for investigating the relative efficacy of the two approaches is proposed. It is suggested that particular attention be paid to such variables as differential attrition, the effect of each modality on the accuracy of self-report, the need for continuing or supplementary therapy, the occurrence of treatment “casualties,” interactions between client characteristics and mode of therapy, and long-term results. In the interim before such data are available, a reasonable clinical recommendation may be the implementation of a “compromise” approach designed to maximize the advantages claimed by each model while minimizing possible risks.     

Partitioned association-linkage test: distinguishing “necessary” from “susceptibility” loci

Marker allele-disease association and linkage between a disease locus and a marker locus are two different phenomena. Linkage without evidence of association and association without evidence of linkage are possible observations. Linkage analysis uses marker loci and the phenomenon of recombination to look for disease-related loci which are presumably major contributors to disease expression (“necessary” loci). However, the phenomenon of association is more complex. One explanation for the existence of an association is that there is a “necessary” locus in linkage disequilibrium with a marker locus. Another explanation is that the marker locus itself (or a closely linked locus in linkage disequilibrium with the marker) is a “susceptibility” locus, which increases the probability of contracting the disease but is not necessary for disease expression. Although there are other possible explanations for the existence of an association, these two can lead to different results when family data from a disease showing association are analyzed for linkage between the associated marker and the disease. If the linkage disequilibrium hypothesis is correct, there will be evidence for linkage. If the susceptibility locus hypothesis is correct, there may be strong evidence against linkage. In this work, we explore a method that could indicate whether an association is due to a susceptibility locus or a necessary locus. We show that, by dividing families based on the presence or absence of the associated marker allele in a randomly chosen affected sib, calculating lod scores, and then calculating a heterogeneity statistic, we could distinguish whether linkage data came from a susceptibility locus or a necessary locus. © 1996 Wiley-Liss, Inc.     

“PEOPLE NOT PIGEONHOLES”

Private O. T. Practitioner specialising in problems of neurological dysfunction — notably in relation to CVA patients and children with specific learning difficulties in normal school situation. This article discusses an aspect of the author's work in relation to children with specific learning difficulties. Through the support and good offices of her local primary school headmaster, there is a current application before the NSW Department of Education School Based Initiatives Program Committee, proposing the employment of an occupational therapist to conduct a remedial program in that school. It proposes that a pilot study document and attempt to define the advantages and desirable extent of such a program, not only for the particular school, but in the development of future Departmental policy. On a recent visit to U.K. the author found her concept hailed enthusiastically as a significant initiative in the present search to deal effectively with the estimated one in five children and young adults who will have some form of special educational needs as evidenced in the report by the Warnock Committee of Enquiry 1978.     

Tracking infants “at risk”

Twelve factors on the birth certificate have been identified as possible indicators of infants at high risk for post-neonatal death, child abuse, cerebral palsy, SIDS and later learning defects. Each factor was given a score of 1, and high risk was identified as 3 + factors. All births in West Virginia in December 1982 were scored, and of the 2,306 live births, 394 were classified as high risk (17%). A control group of 433 infants with a score of 0 were identified. A study was then conducted to see if high risk infants were being followed by the county health department nurses more closely than the low risk infants. The telephone questions were preceded by a letter explaining the study. The nurses responded 100%. The high risk babies were not being more closely watched. Negotiations are being conducted with divisions in the State Department of Health to see if it is possible to implement the procedure to identify possible high risk infants on a regular basis, and notify local health departments of the names and addresses, so that a screening may be conducted in those households to determine if assistance is needed to help the infant develop and grow well.     

Defending a “Never Event”

There are medical mishaps that have been deemed “Never Events” by the Centers for Medicare & Medicaid Services (CMS). This term refers generally to preventable occurrences so egregious that they should never occur. But they do occur. And when they do, litigation often follows. This article focuses on one such Never Event—the operating room fire—with strategies on how to defend it. Information provided in this article was derived from a review of the relevant literature and from the author's personal experience defending lawsuits arising from Never Events, including a jury trial involving a surgeon who was sued for a patient's injuries after a fire erupted in the operating room.     

“Cloud chasers” and “substitutes”: e‐cigarettes,vaping subcultures and vaper identities

The use of e‐cigarettes is increasing, a practice denoted as vaping. We explore user motives, self‐identity as vapers and involvement in vaping subcultures, drawing on sociological theory of stigma, subcultures and symbolic boundaries. Based on analyses of semi‐structured interviews with 30 Norwegian vapers, we find that there is a vaping subculture in Norway. We identify two dominant vaper identities. The first is labelled cloud chasers. These were dedicated vapers who identified with symbols and values in the subculture. Many were politically engaged in improving vaping regulation regimes and felt a sense of belonging to a vaping community. The second group is labelled substitutes. These were former daily smokers who used e‐cigarettes for smoking cessation in a more pragmatic and defensive manner, to avoid health risks, to escape the stigma of smoking and to manage nicotine addiction. In this group, self‐identity as a vaper was generally lacking. Vaping was often symbolically linked to the stigmatised smoker identity they wanted to escape, and was restricted to private contexts. The perceived symbolic meaning of e‐cigarettes varies: for some, they are a symbol of pleasure and community. For others, they connote the stigmatised status of the addicted smoker seeking an alternative to cigarettes.     

Teaching thinking skills: The “what” and the “how” of young children's thinking

This review illustrates current perspectives on young children's thinking, from the viewpoint of developmental psychology. Relevant findings from both cognitive developmental and information processing literatures are discussed. Specific abilities of preschoolers are highlighted, and practical suggestions are offered from both perspectives.